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Run: Energized Electrical Work Permit

Document energized electrical work with the permit details, hazard analysis, PPE, and approvals needed before work begins. Use it to justify why de-energizin...

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Permit Details

Permit Title (required)

Work Order / Job Number

Site / Area / Building (required)

Permit Date (required)

Requested Start Date and Time (required)

Requested End Date and Time

Equipment and Circuit Information

Equipment Name / Tag (required)

Equipment ID / Asset Number

Nominal Voltage (required)

Enter the nominal system voltage, such as 480 V AC or 13.8 kV.

Energized Parts to be Worked On or Near (required)

Current Equipment Condition (required)

Energized Work Justification

Is energized work required? (required)

Why can the equipment not be de-energized? (required)

Work Scope Summary (required)

De-energized Alternatives Considered

Shock and Arc Flash Hazard Analysis

Shock hazard present? (required)

Arc flash hazard present? (required)

Shock Risk Controls

Arc Flash Risk Controls

Incident Energy or PPE Category

Enter the incident energy value or PPE category from the site study or equipment label, if applicable.

Safe Work Practices and PPE

Pre-job briefing completed? (required)

Safe Work Practices to Be Followed (required)

PPE Required (required)

PPE inspected and in serviceable condition? (required)

Personnel and Approvals

Requestor Name (required)

Requestor Role / Title (required)

Qualified personnel assigned? (required)

Approver Name (required)

Approver Title (required)

Approval Status (required)

Acknowledgment

Submitter Signature (required)

Signature Date (required)

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Email (required)

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